| Objective: To analyze the clinical outcomes of salvage chemoradiotherapy for patients with loco-regional recurrent of thoracic esophageal squamous cell carcinoma after curative resection.To evaluate the factors that influence prognosis.Methods: Between January 2010 and December 2015,a total of 110 patients with loco-regional recurrence of thoracic squamous cell carcinoma after curative resection in Nanchong Central Hospital were retrospectively analyzed.Patients were treated with radiotherapy(median 60Gy)combined with chemotherapy.To determine the overall survival and progression-free survival as the primary end point,the objective response rate and toxic effects as the secondary end point.We analyzed the patients and treatment characteristics,including gender,age,location of primary tumor,degree of differentiation,depth of invasion,pathology of lymph nodes,pathologic stage,recurrence site,interval between surgery and recurrence,adjuvant therapy,response to treatment,treatment strategy,radiation dose,3D-CRT or IMRT,chemotherapy regimen.Compared the relationship between various factors and prognosis.Statistical analyses were performed by the SPSS software(version 22.0).The Kaplan-Meier method was used for the survival analysis.Log-rank tests were used for univariate analysis and comparing the survival distributions.Cox proportional hazards model was used for multivariate analysis.The ?2 test was used to evaluate the differences in proportion.A P value of less than 0.05 was considered statistically significant.Results: Objective response rate of the whole group was 72.7%,and the objective response rate of the supraclavicular recurrence was 89.5%,followed by the mediastinum,multi-region,abdominal,and anastomosis.The objective response rates were 83.7% and 63.9% for the concurrent chemoradiotherapy group and sequential chemoradiotherapy group,respectively(P=0.021).The median interval time between surgery and recurrence was 12.5 months.The median progression-free survival period after recurrence was 11.5 months.The median survival period after recurrence was 16.0 months.The progression-free rates at 1,2 and 3 years were 49.5%,25.0% and 13%,respectively.The overall survival rates at 1,2 and 3 years were 57.9%,31.7% and 18.8%,respectively.Univariate analysis showed that depth of invasion,pathology of lymph nodes,pathologic stage,interval between surgery and recurrence,adjuvant radiotherapy,response to treatment,radiation dose were associated with prognosis.(1)The median survival period and 1,2,3 years survival rates of T1+T2 and T3+T4 were 21.0 months and 13.0 months,71.8% and 50.0%,43.6% and 24.6%,25.0% and 15.4%,respectively(P=0.006).(2)The median survival period and 1,2,3 years survival rates of N0 and N+ were 20.5 months and 11.5 months,63.5% and 50.0%,41.9% and 19.0%,27.1% and 0.7%,respectively(P=0.001).(3)The median survival period and 1,2,3 years survival rates of I-IIA and IIB-III were 29.0 months and 13.5 months,75.9% and 51.3%,50.0% and 25.0%,26.9% and 16.0%,respectively(P=0.013).(4)The median survival period and 1,2,3 years survival rates of interval period between surgery and recurrence?12 months and interval period between surgery and recurrence >12 months were 11.0 months and 20.5 months,45.1% and 69.4%,20.4% and 41.8%,10.9% and 38.2%,respectively(P=0.004).(5)The median survival period and 1,2,3 years survival rates of with adjuvant radiotherapy and without adjuvant radiotherapy were 11.0 months and 18.0 months,42.1% and 60.7%,21.1% and 34.1%,0.5% and 21.7%,respectively(P=0.038).(6)The median survival period and 1,2,3 years survival rates of CR+PR and SD+PD were 19.5 months and 9.0 months,68.8% and 25.9%,36.4% and 18.5%,23.0% and 0.7%,respectively(P=0.000).(7)The median survival period and 1,2,3 years survival rates of radiation does<60Gy and radiation does?60Gy were 11.5 Months and 19.5 months,45.8% and 67.8%,25.0%,and 37.5%,10.6% and 24.1%,respectively(P=0.006).In multivariate analysis,pathology of lymph nodes,interval between surgery and recurrence,response to treatment,radiation dose were independent prognostic factors for survival.Conclusion: Salvage chemoradiotherapy is an effective treatment for loco-regional recurrent thoracic esophageal squamous cell carcinoma after curative resection.Compared with sequential chemoradiotherapy,concurrent chemoradiotherapy can significantly improve the objective response rate and may prolong the survival period.Patients can tolerate radiotherapy with involved field irradiation and radiation dose of 60 Gy,but for patients with anastomotic recurrence with high risk factors of radiotherapy,dose higher than 50 Gy should be cautious in concurrent chemoradiotherapy.The clinical efficacy between cisplatin and nedaplatin is similar in salvage chemoradiotherapy for thoracic esophageal squamous cell carcinoma after curative resection.For patient who cannot receive intravenous chemotherapy,S-1 may be a substitute.Patients with pathology of lymph nodes was N0,interval period between surgery and recurrence longer than 12 months,highly objective response rate,dose of radiaotion?60Gy have better prognosis. |
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